Affiliation:
1. From the Krakow Centre for Medical Research and Technologies, John Paul II Hospital, Poland (M.Z., A.U.); Data Analysis Center, Krakow Cardiovascular Research Institute, Poland (K.P.); Department of Mechanical Engineering, Cracow University of Technology, Krakow, Poland (W.W.); and Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland (A.U.).
Abstract
Objective—
Pulmonary embolism (PE) is a life-threatening manifestation of venous thromboembolism with a high recurrence rate after anticoagulation cessation. Recently, we have reported that prothrombotic clot phenotype in venous thromboembolism patients is associated with an increased risk of recurrent deep-vein thrombosis.
Approach and Results—
We tested whether abnormal clot properties are predictive of recurrent PE. We investigated 156 consecutive white patients aged 18 to 65 years after the first-ever provoked or unprovoked PE (n=89), with or without deep-vein thrombosis. Plasma fibrin clot permeability (K
s
), turbidity measurements, calibrated automated thrombography, and efficiency of fibrinolysis using clot lysis time, maximum D-dimer levels, and rate of increase in D-dimer levels were evaluated at ≥3 months of anticoagulant therapy, at least 4 weeks since the anticoagulation withdrawal. The primary end point was recurrent PE during a median follow-up of 50 months. Recurrent PE was diagnosed in 23 (14.7%; 5%/yr) patients. Recurrent PE was associated with formation of denser fibrin networks reflected by lower K
s
(
P
=0.007) and impaired fibrinolysis, as evidenced by prolonged clot lysis time (
P
=0.012) and reduced maximum rate of increase in D-dimer levels in the lysis assay (
P
=0.004). Patients with recurrent PE had higher plasma D-dimer (
P
<0.001) and thrombin peak (
P
=0.007) compared with the remainder, whereas turbidity measurements and maximum D-dimer levels did not differ in the recurrence. Multivariate model showed that independent predictors of recurrent PE were female sex, unprovoked venous thromboembolism, higher plasma D-dimer, reduced K
s
, and reduced maximum rate of increase in D-dimer levels in the lysis assay (all
P
<0.05).
Conclusions—
Altered fibrin clot properties including formation of more compact clots displaying impaired susceptibility to lysis may predispose to recurrent PE.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
52 articles.
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